Persistant pain after L1 compression fracture

Bones, joints and muscles
1

Hi,

beginning of September 2014, I fell off a ladder (about 2m high), right on my lowerback/buttocks. I was diagnosed with a L1 compression fracture (anterior is compressed by 37%), was hospitalized for a week, and had to wear a back brace. November 11th, dr did an MRI because I was in so much pain. It showed oedema in the fracture which meant that it hadn't healed entirely (that's what he told me), also showed minimal deviation of posterior wall with some angulation, narrowing of the spinal canal and mainly the anterior liquor space. pressure on the dural sac, neuroforaminae intact.

Wore the brace until end of January 2015, trying to gradually leave it off for longer and longer periods of time (very painful). Dr seemed to have 'forgotten' to prescribe physiotherapy. Started that end of Jan. Seen him again 2 weeks ago, being very impolite with me because I told him I'm still in a lot of pain, daily. He told me he doesn't believe me. I also have numb areas around my belly button, next to my spine, my buttocks suddenly turn ice cold and numb when sitting for about an hour. Lots of intestinal disturbance too. I go out and walk a lot, do the physiotherapy three times a week, do the household, cook and light grocerie shopping. But I'm floored after a few hours. Working on the computer is very painful (static position), I have to lay down after about an hour and a half. 

The rudeness of this orthopedist is stunning to me, so I booked an appointment with a neurosurgeon in another hospital. 

Could someone give me more information about this? Is this long healing time normal? Do the MRI resullts indicate a possible neurological issue?

Thank you very much!

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Whichever Dr told you he doesn't believe you should not be in his profession.  Spinal injuries can lead to long term pain - I know, as years ago I slipped on a shiny surface and landed on my lower spine/buttocks.  I had loads of X-rays and was diagnosed with spondilolisthesis - the impact of the fall had caused slippage of vertebra which makes up the spine.  I saw a few different orthopeadic consultants over the years and whereas some suggested a spinal fusion op, the final one examined my X-rays and spine, saying that the deviation was so large that he would be able to balance a pint of beer on it!  But importantly he advised me against surgery, saying that it would be major, with a disc having to be removed as well.  He arranged for me to be measured for a surgical corset and advised me to get in the water and swim but only on my back.  An osteopath showed me some simple exercises to strengthen all the muscles around the stomach and spine to support the injury.  I have experienced some painful episodes over the years which have laid me low, but after ensuring that I always sit in only supportive chair(including the car seat_ and sleep on only supportive beds, get in and out of the car and in and out of the bed in a certain way, I keep pain away.  I also had to stop using the vacuum cleaner as it became obvious that could easily trigger an attack.  I have also had a few long episodes of severe sciatica where the pain travels down the side of the leg from the hip to the foot - even a slight stumble can cause this.  Walking daily is also of great benefit.  Providing I keep away from the known triggers, I have kept reasonably pain-free for years, but on occasion when my back does let me down, I don a simple support girdle (the surgical corset no longer fits!) and have relief within a couple of days.

We're not medics on here so, of course, are unable to answer your question as to whether your MRI results indicate a neurological issue, but I can say that any injury to the spine could affect the surrounding nerves.  Good luck with your neuro appointment.

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Hi Marlenes. I agree w/ what MrsO said. We are just like you, some have physical processes and symptoms more than others but generally we

are all hitting this forum up for comparisons for what we are or have been through. The only difference for me is that I am in the States, while you are in the UK. I have talked to several people from Ausralia, but that is about it. Briefly, I am a 67 yr old retired RN (Orthopedic Trauma Surg)

who lifted one too many heavy patients during her career. I am currently

4 1/2 months post L4-L5 Decompression Laminectomy, Disectomy, and fusion with bone grafting anterior approach. I also had lumbar stenosis that I Wasn't bothered with until the disc heriated in Sept 2013. I worked

with the neurosurgeon that did my surgery...top in

his field....and it still took me 13 months to get into the operating room,

the later 3 months I experienced sudden complete loss of motor function

in both legs and I would end up falling flat on my face. I can tell you that my pain for the final 7 months was excruciating and 600mg of OTC

Ibuprophen every 6 hrs was my only salvation. Well, you might as well

add a back brace, a swivel seat for my car and a cold pack (ice) to that.

I cannot imagine not having the knowledge to treat myself while I had to.

The time it takes seems to be guided by how busy the doc is, how long it takes you to go for Xrays, the results to reach the doc and you to get an

appt to see what they are and what the doc is going to do for you. God

forbid you should then need an MRI..the road scenario repeats.

Now to your predicament. You were dx'd w/ an L1 compression fracture

6 months ago, placed in a corsett brace, and sent home. You started your own physical therapy treatments? Do you feel that they are helping? And, by any chance was the numbness before or after? Numbness is typical, also deep itching under the numb area. Twisting, bending, and lifting will worsen symptoms/pain. The act of sitting tends to involve all of the

lumbar spine and therefor causes pain. Different nerves innervate different areas of the lower body from thighs down. And even though I wasn't

experiencing bowel and/or bladder problems, the surgeon seemed

surprised that I wasn't. I also have a jolt of extreme discomfort if I step down wrong on uneven ground, so don't worry. Just take note of what you are doing that hurts you and learn to avoid doing it again. I was house-

bound for the first 6 wks after surgery, able to walk in the house as much as I could. No sitting for the first 2 weeks and only for 10-15min for the next four...but I could walk outside@the 4th week. I knew that if I forgot

and twisted sitting in a chair, changing positions in bed, and getting in and out of the drivers seat it was going to cause pain, so I armed myself with that back brace (you will need the corsett brace instead) and a swivel seat that I purchased for less than $25. I am able to work

in the garden now and I can push a vacuum if I take it easy, but my flank

muscles still manage to let me know when they've had enough and I need to rest them.

From fall off ladder to now is 6 months. I think you made a wise decision to look for a neurosurgeon. A thought: did Dr I Don't Care happen to

write a prescription for an anti-inflamatory med for the edema? You never mentioned a script for pain med. The docs here in the US don't write for narcotics as readily as they used to either. Too much abuse going on.

Honestly, I took Lortab twice daily combined with Robaxin and traded the Lortab for Ibuprophen at 10 days. That works for me quite well, but I do not have stomach problems that prevent me from taking it.

Good luck and I hope that I have been able to give you some insight.

Patricia

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Thank you very much for your replies!

@MrsO,

I think my orthopaedist has made several mistakes: no supplements (Vit D, calcium - I also have Lyme Disease, which means that maybe my bone density has been affected - but he never bothered to check it), physiotherapy only after 5 months.

@patricia4866,

I'm Belgian I have no place here where I can try to get in touch with people that can relate to what I'm dealing with... I only have this nitwit doctor not willing to even listen to my complaints... I took Diclophenac the first 8 weeks, then I stopped. As for painmeds, I can't tolerate Tramadol (makes me very nauseous), and it doesn't help, Ibuprofen, Paracetamol, nothing helps. I'm on Low Dose Naltrexone for Lyme Disease symptoms, and that sometimes seems to take the edge off...

I started the physio after 5 months, per his prescription, after I asked for it. It gave me a lot more mobility and flexibility, but almost no help with the pain. It took away part of the muscle tension in my back though. Part of the numbness was there right after the fall and is still present (around belly button), as are the bowel issues, the numbness around my spine is more recent, the cold buttocks area started somewhere halfway the whole process. I get the itching too, didn't know about that, I thought it was maybe an old shingles scar showing off.

I have a corsett brace (sorry, thought that was the same as a back brace), but the orthopaedist told me to never touch it again. My flank muscles are killing me, it's like they are on fire, ready to collaps. When it gets too much to handle I have to lay down.

The problem is that I'm scared that the doctors will say I will have to start working again, but I can't even imagine having to sit behind a desk for 9hrs per day... I simply can't...

Thank you both for your replies!! I really appreciate it.

 

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No one told me to buy a back brace, I did that on my own to get through

the 12 hr shifts I was working till I retired at the end of May 2014. After

surgery my surgeon told me not to use it anymore, but I didn't trust

myself to go to bed at night and NOT twist when I turned over in my

sleep, so I wore it to bed every night as a means not to break my spinal

restrictions.

(BLT's) No bending, lifting, or twisting. Your injury is at L1, hence the

corsett brace for ridgid support higher on the lumbar spine. Mine is one

of those bulky black elastic and velcro ones that give more support to

the lower lumbar area. I have burning in my right flank, but only when I have been doing something to bring it on...like weeding the garden. When

it happens, I stop the action that caused it, I take my Ibuprophen if I can.

If not, I take a Robaxin muscle relaxer until the burning ceases and I am able to resume. The body takes time to heal...give it the time it needs, but I would definitely do some research into nearby neurosurgeons. There should be some kind of a registry or hotline to obtain thr rating of each one. Go on their website and look for patients that are happy with their work or dissatisfied. Also, if there is a university hospital close that also is also associated with a medical college where they train the med students

through 5 yrs of residency before they then lea e to train directly with a surgeon for a year. You then look up the Department Chair (head of) and do your best to get an appointment with him/her or their Assistant Chair. I went to the Assistant Chair bc the Chair is too old to operate but is too good to ask to step down from the position. In a way I cheated bc I worked at that hospital and I knew the docs there, esp the Ortho and Neuro docs. And to answer your question about the MRI. Yes, they can show up

neuro problems that standard Xray cannot. Xray showed my stenosis but not the spurs or the arthritis or the herniated disc. I hope you feel better soon. Keep going with the physio. I you stop, the flank muscles will

atrophy.

Patricia

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That was supposed to read that if you stop the flank muscles will

atrophy.

Patricia

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I broke my  l I vertebrae 4 years ago & im still in pain. I'm limited to what activity I can do , I had line dancing lesson last night & today I'm in severe pain , can anyone tell me how do you build up your core 

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I’m having the same issue.  I have a compression fracture to the L1 vertabrae. First doctor I went to told me there was nothing broken, that it was muscular. He poked me full of steroids and sent me on my way. I got in to see an orthopedic doc the next day who also told me nothing was broken. I told him about my pain and he decided to look again and said “oh, it is broken”. Duh. I also told him my tailbone was broken, that I had broken it before. He sent me for an MRI and confirmed the L1 fracture. I asked about the broken tailbone and he said he didn’t check that. It’s been seven weeks and I still have a lot of pain and he’s not refilling my pain meds. I’m not a junky, but all these doctors are convinced everyone is just looking for pain meds. I feel your pain!!

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Hi Marlenes I think i have the same condition as you, can you tell me what the outcome was please?
Thank you
Andree